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      Homeless people under the influence of alcohol admitted to hospital emergency departments in Poland

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          Abstract

          Aim:

          To assess the incidence of diagnoses related to alcohol use in the population of homeless people admitted to hospital emergency departments (EDs).

          Material and method:

          Data were analysed from three hospitals concerning stays of homeless people in three EDs in Bydgoszcz, Poland, in 2013–2015; 3133 stays were identified. The data were compiled using Microsoft Excel and Statistica 10 statistical software.

          Results:

          At the time of admission to EDs, 31% of homeless people were considered to be under the influence of alcohol. Diagnoses related to alcohol use accounted for 25% of all diagnoses. The average blood alcohol concentration in the patients was 2.97 per mille. The average blood alcohol concentration in the group of men was significantly higher than that in the group of women ( p = 0.015). The average length of stay in the ED of patients under the influence of alcohol was significantly longer ( p < 0.0001) than among sober patients.

          Conclusions:

          Homeless people under the influence of alcohol account for a third of the population of homeless patients admitted to hospital emergency departments, while alcohol-related ICD-10 diagnoses account for a fourth of all diagnoses in these patients. Homeless patients under the influence of alcohol stay longer in hospital emergency departments than do sober homeless people, which may translate into more frequent acts of aggression towards medical personnel. In Poland there are no systemic ED-level solutions as regards dealing with homeless patients for whom alcohol dependence is in many cases a reality.

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          Factors associated with the health care utilization of homeless persons.

          Margot Kushel (2001)
          Homeless persons face numerous barriers to receiving health care and have high rates of illness and disability. Factors associated with health care utilization by homeless persons have not been explored from a national perspective. To describe factors associated with use of and perceived barriers to receipt of health care among homeless persons. Secondary data analysis of the National Survey of Homeless Assistance Providers and Clients. A total of 2974 currently homeless persons interviewed through homeless assistance programs throughout the United States in October and November 1996. Self-reported use of ambulatory care services, emergency departments, and inpatient hospital services; inability to receive necessary care; and inability to comply with prescription medication in the prior year. Overall, 62.8% of subjects had 1 or more ambulatory care visits during the preceding year, 32.2% visited an emergency department, and 23.3% had been hospitalized. However, 24.6% reported having been unable to receive necessary medical care. Of the 1201 respondents who reported having been prescribed medication, 32.1% reported being unable to comply. After adjustment for age, sex, race/ethnicity, medical illness, mental health problems, substance abuse, and other covariates, having health insurance was associated with greater use of ambulatory care (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.19-5.42), inpatient hospitalization (OR, 2.60; 95% CI, 1.16-5.81), and lower reporting of barriers to needed care (OR, 0.37; 95% CI, 0.15-0.90) and prescription medication compliance (OR, 0.35; 95% CI, 0.14-0.85). Insurance was not associated with emergency department visits (OR, 0.90; 95% CI, 0.47-1.75). In this nationally representative survey, homeless persons reported high levels of barriers to needed care and used acute hospital-based care at high rates. Insurance was associated with a greater use of ambulatory care and fewer reported barriers. Provision of insurance may improve the substantial morbidity experienced by homeless persons and decrease their reliance on acute hospital-based care.
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            Homelessness and health.

            Shin Hwang (2001)
            Homelessness affects tens of thousands of canadians and has important health implications. Homeless people are at increased risk of dying prematurely and suffer from a wide range of health problems, including seizures, chronic obstructive pulmonary disease, musculoskeletal disorders, tuberculosis, and skin and foot problems. Homeless people also face significant barriers that impair their access to health care. More research is needed to identify better ways to deliver care to this population.
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              Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics.

              Molly Byrne, Andrew William Murphy, Patrick Plunkett … (2003)
              We describe, in comparison with a control group, frequent attenders to an emergency department in terms of their general health service use and their clinical, psychological, and social profiles. One hundred frequent attenders (those who had made > or =4 visits in the previous year) and 100 nonfrequent attenders matched for sex, age, and triage category were interviewed in the ED. Data were gathered on health service use, mental health (by using the General Health Questionnaire-12 item), and perceived social support (by using the Multidimensional Scale of Perceived Social Support). Patients' general practitioners were contacted to validate attendance data. Medical charts were searched for evidence of psychological problems and alcohol or drug abuse. In the overall sample of 200 patients, 32% were female, and the mean age was 55 years (SD 20). Frequent attenders had made more visits to their general practitioner in the past year compared with control patients (median 12 versus 3 visits); a higher proportion of frequent attenders had used public health nursing services, community welfare services, social work services, addiction counseling, and psychiatric services in the past year. Frequent attenders had made more other hospital visits and had spent more nights in the hospital than control patients. General Health Questionnaire-12 item scores were higher for frequent attenders than control patients, indicating poorer mental health. Frequent attenders had lower levels of perceived social support. Frequent attenders to the ED are also heavy users of general practice services, other primary care services, and other hospital services. General Medical Services-eligible patients (84% of frequent attenders) frequently attend the ED, even though they have free access to primary care. Frequent attenders are a psychosocially vulnerable group, and service providers and policy makers need to take account of this vulnerable patient profile as they endeavor to meet their service needs.
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                Author and article information

                Contributors
                Anna Burak:
                ORCID: https://orcid.org/0000-0002-9541-7268
                Katarzyna Cierzniakowska
                Aleksandra Popow
                Journal
                Journal ID (nlm-ta): Nordisk Alkohol Nark
                Journal ID (iso-abbrev): Nordisk Alkohol Nark
                Journal ID (publisher-id): NAD
                Journal ID (hwp): spnad
                Title: Nordisk alkohol- & narkotikatidskrift : NAT
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 1455-0725
                ISSN (Electronic): 1458-6126
                Publication date (Electronic): 1 May 2020
                Publication date (Print): April 2020
                Volume: 37
                Issue: 2
                Pages: 190-200
                Affiliations
                [1-1455072520908387]Nicolaus Copernicus University, Toruń, Poland
                [2-1455072520908387]Nicolaus Copernicus University, Toruń, Poland
                [3-1455072520908387]Nicolaus Copernicus University, Toruń, Poland
                Author notes
                [*]Anna Burak, Department of Accident and Emergency Medicine, Collegium Medicum, Nicolaus Copernicus University in Toruń, University Hospital no. 2 in Bydgoszcz, Jagiellońska 13/15, 85-067 Bydgoszcz, Poland. Email: anna_burak@ 123456wp.pl
                Author information
                https://orcid.org/0000-0002-9541-7268
                Article
                Publisher ID: 10.1177_1455072520908387
                DOI: 10.1177/1455072520908387
                PMC ID: 7434175
                SO-VID: ece98fea-b2df-4f08-a1e2-b23618c20b36
                Copyright © © The Author(s) 2020
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 18 April 2019
                Date accepted : 20 January 2020
                Categories
                Subject: Research Reports
                Custom metadata
                typesetter ts3

                Keywords: alcohol,homelessness,hospital emergency department
                Data availability:
                Keywords: alcohol, homelessness, hospital emergency department

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